Personal recovery is associated with many significant health-related factors, but studies exploring associations between activity factors and personal recovery among service users are scarce. The aims of this study were hence to; 1) investigate if various aspects of activity may mediate change in recovery while also acknowledging clinical, sociodemographic and well-being factors; 2) explore the effects of two activity-based interventions, Balancing Everyday Life (BEL) or standard occupational therapy (SOT), on personal recovery among service users. Two-hundred-and-twenty-six service users were included in a cluster RCT, 133 from BEL units and 93 from SOT units. Participants commonly had a diagnosis of mood disorder and the mean age was 40. Instruments used targeted activity, mastery and functioning. A mixed-model regression analysis was employed. The model tested was whether selected variables could be used to mediate the change in recovery from the start to a six-month follow-up after intervention. Participants’ personal recovery increased after treatment and increased further at the follow-up. The general level of recovery was negatively related to a diagnosis of depression/anxiety, both before and after treatment, but depressed/anxious service users still increased their recovery. There were no significant relations between recovery and sex or age. The interactions between change in recovery and changes in depression/anxiety, satisfaction with activities, sex, and age were all non-significant. All possible treatment mediators included were related to change in recovery, the strongest being occupational engagement and mastery, followed by activity satisfaction and symptoms. Mediation was shown by the decrease in the effect of the time factor (from intervention start to completion) when the covariates were introduced. In all cases the time variable was still significant. When testing a model with all variables simultaneously as covariates, occupational engagement and mastery were strongly significant. There was no difference between interventions regarding recovery improvement. The treatments were equally beneficial and were effective regardless of gender, age and diagnosis. Those who gained most from the treatment also gained in feelings of mastery and activity engagement. Activity engagement also moderated the level of recovery. To enhance recovery, interventions should facilitate meaningful activities and gaining control in life. The study was registered with ClinicalTrials.gov . Reg. No. NCT02619318 . Retrospectively registered: December 2, 2015.

中文翻译：

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使用基于聚类RCT数据的混合模型回归分析，探索心理健康服务用户随着时间的推移恢复过程的中介者

个人康复与许多重要的健康相关因素有关，但缺乏研究活动因素与服务使用者个人康复之间关系的研究。因此，本研究的目的是：1）调查活动的各个方面是否可以介导恢复的变化，同时也要认识到临床，社会人口统计学和幸福因素；2）探索两种基于活动的干预措施，即平衡日常生活（BEL）或标准职业治疗（SOT）对服务使用者个人恢复的影响。集群RCT中包括262个服务用户，其中BEL单元133个，SOT单元93个。参与者通常诊断为情绪障碍，平均年龄为40岁。仪器使用了针对性的活动，精通和功能。采用了混合模型回归分析。测试的模型是选择的变量是否可用于介导从开始到干预后六个月随访的恢复变化。参与者的个人康复情况在治疗后有所增加，并在随访中进一步增加。康复的总体水平与治疗前后抑郁/焦虑的诊断呈负相关，但抑郁/焦虑的服务使用者仍能提高其康复程度。恢复与性别或年龄之间没有显着关系。恢复的变化与抑郁/焦虑的变化，对活动的满意度，性别和年龄之间的相互作用均不显着。包括的所有可能的治疗介体都与恢复的变化有关，最强烈的是职业参与和精通程度，其次是活动满意度和症状。当引入协变量时，时间因素的影响（从干预开始到完成）的减少表明了中介作用。在所有情况下，时间变量仍然很重要。当同时使用所有变量作为协变量测试模型时，职业敬业度和精通度非常重要。干预措施之间在恢复改善方面没有差异。无论性别，年龄和诊断如何，治疗都是同样有益且有效的。那些从治疗中获得最大收益的人也获得了精通和积极参与的感觉。活动参与也减缓了恢复水平。为了促进康复，干预措施应促进有意义的活动并控制生活。该研究已在ClinicalTrials.gov上注册。Reg。No.NCT02619318。